- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,285.76 / $9,062.00 / $22,776.00
| Facility | | $1,285.76 | $9,062.00 | $22,776.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $560.00 / $615.00
| Facility | | $100.00 | $560.00 | $615.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $121.47 / $121.47 / $121.47
| Facility | AS | $121.47 | $121.47 | $121.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,110.34 / $1,347.26 / $2,203.28
| Facility | | $1,110.34 | $1,347.26 | $2,203.28 |
- Facility/Professional
- Facility
- Modifier
- 80
- Low / Median / High Price
- $263.83 / $269.45 / $403.40
| Facility | 80 | $263.83 | $269.45 | $403.40 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $184.69 / $188.62 / $282.38
| Facility | AS | $184.69 | $188.62 | $282.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $600.00 / $5,871.00 / $8,973.00
| Facility | | $600.00 | $5,871.00 | $8,973.00 |